Provider Demographics
NPI:1982678801
Name:WELCH, LESLIE KINSAUL (ATC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:KINSAUL
Last Name:WELCH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 WATERMELON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5008
Mailing Address - Country:US
Mailing Address - Phone:205-283-4968
Mailing Address - Fax:
Practice Address - Street 1:5690 WATERMELON RD STE 100
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5008
Practice Address - Country:US
Practice Address - Phone:205-759-2211
Practice Address - Fax:205-759-2213
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
030402135OtherNATIONAL ATHLETIC TRAINERS BOARD OF CERTIFICATION